Provider Demographics
NPI:1154570760
Name:BURCH-BURKHALTER, ELLEN SHEA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:SHEA
Last Name:BURCH-BURKHALTER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2257 TAYLOR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7790
Mailing Address - Country:US
Mailing Address - Phone:334-270-9914
Mailing Address - Fax:334-270-3195
Practice Address - Street 1:4712 BERRY BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3080
Practice Address - Country:US
Practice Address - Phone:334-834-3094
Practice Address - Fax:334-263-0598
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2010-11-09
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Provider Licenses
StateLicense IDTaxonomies
ALPA-593363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant